Randomized controlled trial of specific spinal stabilization exercises and conventional physiotherapy for recurrent low back pain

Study Design. Pragmatic, multicentered randomized controlled trial, with 12-month follow-up. Objective. To evaluate the effect of adding specific spinal stabilization exercises to conventional physiotherapy for patients with recurrent low back pain (LBP) in the United Kingdom. Summary of Background Data. Spinal stabilization exercises are a popular form of physiotherapy management for LBP, and previous small-scale studies on specific LBP subgroups have identified improvement in outcomes as a result. Methods. A total of 97 patients (18-60 years old) with recurrent LBP were recruited. Stratified randomization was undertaken into 2 groups: conventional, physiotherapy consisting of general active exercise and manual therapy; and conventional physiotherapy plus specific spinal stabilization exercises. Stratifying variables used were laterality of symptoms, duration of symptoms, and Roland Morris Disability Questionnaire score at baseline. Both groups received The Back Book, by Roland et al. Back-specific functional disability (Roland Morris Disability Questionnaire) at 12 months was the primary outcome. Pain, quality of life, and psychologic measures were also collected at 6 and 12 months. Analysis was by intention to treat. Results. A total of 68 patients (70%) provided 12-month follow-up data. Both groups showed improved physical functioning, reduced pain intensity, and an improvement in the physical component of quality of life. Mean change in physical functioning, measured by the Roland Morris Disability Questionnaire, was -5.1 (95% confidence interval -6.3 to -3.9) for the specific spinal stabilization exercises group and -5.4 (95% confidence interval -6.5 to -4.2) for the conventional physiotherapy group. No statistically significant differences between the 2 groups were shown for any of the outcomes measured, at any time. Conclusions. Patients with LBP had improvement with both treatment packages to a similar degree. There was no additional benefit of adding specific spinal stabilization exercises to a conventional physiotherapy package for patients with recurrent LBP.